Provider Demographics
NPI:1528894896
Name:TANGREDI, KAITLIN (LCSW)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:TANGREDI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 LAKEVILLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1103
Mailing Address - Country:US
Mailing Address - Phone:516-708-2520
Mailing Address - Fax:
Practice Address - Street 1:410 LAKEVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1103
Practice Address - Country:US
Practice Address - Phone:516-708-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109943104100000X
NY0995731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker